Digestive and Liver Disease最新文献_第4页

Current management of hepatobiliary malignancies between centers with or without a liver transplant program: A multi-society national survey 有肝移植计划或没有肝移植计划的中心对肝胆恶性肿瘤的管理现状：多学会全国调查。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.09.007

Matteo Serenari , Roberta Angelico , Quirino Lai , Damiano Patrono , Irene Scalera , Emanuele Kauffmann , Duilio Pagano , Riccardo De Carlis , Enrico Gringeri , Alessandro Vitale

Background

Availability of liver transplantation (LT) as a treatment for hepatocellular carcinoma (HCC) and other liver malignancies may determine heterogeneity of therapeutic strategies across different centers.

Aims

To investigate the practice between hepato-biliary centers without (HB centers) and with a LT program (LT centers), we launched a 38-item web-based national survey, with directors of centers as a target.

Methods

The survey, including 4 clinical vignettes, collected data on their approach to HCC and transplant oncology.

Results

After duplicates removal, 75 respondents were considered. Respondents from LT centers (n = 22, 29.3 %) were more in favor of LT in the case of HCC outside Milan criteria (90.9 % vs. 67.9 %, p = 0.037), recurrent HCC (95.5 % vs. 50.9 %, p = 0.002) and other malignancies such as cholangiocarcinoma or neuroendocrine tumors. No significant difference was observed concerning the proportion of centers favorable to LT for unresectable colorectal liver metastases (100 % vs. 88.7 %, p = 0.100).

Conclusion

This national survey showed how management of HCC and awareness of transplant oncology may differ between HB and LT centers. Effective networking between HB and LT centers is crucial to provide optimal treatment and access to LT.

背景：目的：为了调查没有肝移植项目的肝胆中心（HB中心）和有肝移植项目的肝胆中心（LT中心）之间的实践情况，我们以各中心主任为对象，开展了一项包含38个项目的全国性网络调查：调查包括 4 个临床小故事，收集了有关 HCC 和移植肿瘤学方法的数据：结果：去除重复数据后，共有 75 名受访者。来自LT中心的受访者（n = 22，29.3%）更倾向于LT治疗米兰标准以外的HCC（90.9% vs. 67.9%，p = 0.037）、复发性HCC（95.5% vs. 50.9%，p = 0.002）以及胆管癌或神经内分泌肿瘤等其他恶性肿瘤。对于无法切除的结直肠肝转移瘤，接受LT治疗的中心比例无明显差异（100% vs. 88.7%，p = 0.100）：这项全国性调查显示，肝转移癌和肝癌晚期治疗中心对肝转移癌的管理以及对移植肿瘤学的认识可能存在差异。HB 和 LT 中心之间建立有效的网络联系对于提供最佳治疗和获得 LT 至关重要。

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引用次数: 0

Hepatic artery stenosis after pediatric liver transplantation: The potential role of conservative management 小儿肝移植术后肝动脉狭窄：保守治疗的潜在作用。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.09.021

Weihao Li , Thomai Kotsou , Hermien Hartog , Rene Scheenstra , Vincent E. de Meijer , Martin W. Stenekes , Martijn V. Verhagen , Reinoud P.H. Bokkers , Hubert P.J. van der Doef

Aim

This study aimed to investigate the outcomes and effectiveness of various treatment strategies in patients with hepatic artery stenosis (HAS) after pediatric liver transplantation (pLT).

Methods

This is a single center observational cohort study between January 1st, 2004 and August 1st, 2023, including pLT recipients aged <18 years. The primary outcome was graft and patient survival. The secondary outcomes included incidence of biliary complications, technical success of surgery or endovascular therapy (EVT), and changes in liver function. The cut-off for early and late HAS was 14 days after pLT.

Results

Among a total of 327 pLT patients, 4 % (n = 13) developed HAS (n = 3 early; n = 10 late). Treatments included surgical revascularization for one early HAS, conservative management with anticoagulation for one early and four late HAS, and EVT for one early and six late HAS. Over a median follow-up of 28.2 months after the diagnosis of HAS, graft survival was 100 % and 83 % in early and late HAS groups, and patient survival reached 100 % in both groups. One graft loss occurred in the conservative group. Conversely, graft survival in the EVT group was 100 %.

Conclusion

The long-term outcomes of HAS after pLT are excellent. Both EVT and conservative management exhibited high graft survival rates for late HAS, with EVT achieving high technical success.

目的：本研究旨在探讨小儿肝移植（pLT）后肝动脉狭窄（HAS）患者各种治疗策略的结果和有效性：这是一项2004年1月1日至2023年8月1日期间的单中心观察性队列研究，研究对象包括年龄较大的小儿肝移植受者：在总共 327 例 pLT 患者中，4%（n = 13）出现 HAS（n = 3 例早期患者；n = 10 例晚期患者）。治疗方法包括：对 1 例早期 HAS 实施血管重建手术；对 1 例早期 HAS 和 4 例晚期 HAS 实施抗凝保守治疗；对 1 例早期 HAS 和 6 例晚期 HAS 实施 EVT。在确诊 HAS 后 28.2 个月的中位随访期间，早期和晚期 HAS 组的移植物存活率分别为 100% 和 83%，两组患者的存活率均为 100%。保守治疗组出现了一次移植物丢失。相反，EVT 组的移植物存活率为 100%：结论：PLT术后HAS的长期疗效非常好。EVT和保守治疗对晚期HAS的移植物存活率都很高，其中EVT的技术成功率很高。

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引用次数: 0

Safety of endoscopist-directed nurse-administered sedation in an Italian referral hospital: An audit of 2 years and 19,407 procedures 意大利一家转诊医院由内镜医师指导护士使用镇静剂的安全性：对 2 年和 19,407 例手术的审计。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.10.007

R. Conigliaro , F. Pigò , M. Gottin , G. Grande , S. Russo , S. Cocca , M. Marocchi , M. Lupo , M. Marsico , S. Sculli , H. Bertani

Background and study aims

Balanced propofol sedation (BPS) administered by adequately trained non-anaesthesiologist personnel has gained popularity in GI endoscopy because of its shorter procedure and recovery time, high patient satisfaction, and low rate of adverse events (AEs), despite being considered controversial. We report data from an audit of endoscopist-directed (ED) nurse-administered sedation in an Italian referral hospital.

Patients and methods

Consecutive endoscopic procedures performed between 2020 and 2022 were considered. Under the guidance of the endoscopist, the nurse administered midazolam/fentanyl, followed by a progressive top-up dosage of a 10–20 mg bolus of propofol to achieve moderate to deep sedation. The endoscopists and nurses were all certified in our hospital with a continuous and scheduled training from 2006.

Results

During the study period, a total of 19,407 examinations (7,803 EGDS, 10,439 colonoscopies, 77 PEG, 697 EUS, and 365 ERCP) and 14,415 patients were included. Of these, 29.4 % of patients were classified as ASA I, 66.5 % as ASA II, and 5.1 % as ASA III. Hypotension was recorded in 1,293 (6 %) examinations and bradycardia in 176 (0.9 %) patients. Eleven patients (0.06 %) had minor respiratory adverse events. Two patients (0.01 %) had major AEs requiring orotracheal intubation.

Conclusions

ED-BPS is safe in low-risk patients. Major AEs occurred in 0.01 % of procedures.

背景和研究目的：由训练有素的非麻醉师人员实施的平衡异丙酚镇静（BPS）因其手术和恢复时间短、患者满意度高、不良事件（AEs）发生率低而在消化道内镜检查中越来越受欢迎，尽管这还存在争议。我们报告了一家意大利转诊医院对内镜医师指导（ED）护士管理镇静剂的审计数据：研究对象为 2020 年至 2022 年期间进行的连续内窥镜手术。在内镜医师的指导下，护士使用咪达唑仑/芬太尼，然后逐步补充 10-20 毫克的异丙酚，以达到中度到深度镇静的效果。内镜医师和护士都是本医院的认证人员，从2006年开始接受持续和定期的培训：研究期间，共纳入了 19,407 例检查（7,803 例 EGDS、10,439 例结肠镜检查、77 例 PEG、697 例 EUS 和 365 例 ERCP）和 14,415 名患者。其中 29.4% 的患者被划分为 ASA I 级，66.5% 为 ASA II 级，5.1% 为 ASA III 级。在 1,293 例（6%）检查中记录到低血压，在 176 例（0.9%）患者中记录到心动过缓。11名患者（0.06%）出现了轻微的呼吸系统不良反应。两名患者（0.01%）出现了需要气管插管的严重不良反应：结论：ED-BPS 对低风险患者是安全的。结论：ED-BPS 对低风险患者是安全的，发生重大 AE 的比例为 0.01%。

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引用次数: 0

Duodenal gastric heterotopia diagnosed by spectral CT 通过光谱 CT 诊断的十二指肠胃异位症。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.10.019

Bo Duan, Ying Zhao, Hongliang Li, Qingyu Ji

引用次数: 0

Small bowel metastasis from pulmonary pleomorphic carcinoma 肺多形性癌的小肠转移。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.10.023

Kevin Sarti , Marie-Cécile Nollevaux , Jean-François Rahier

引用次数: 0

NOSTRIN is an emerging positive regulator of decompensated cirrhotic patients with portal hypertension NOSTRIN 是门静脉高压肝硬化失代偿期患者的一种新兴负调控因子。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.08.050

Balasubramaniyan Vairappan , Ravikumar TS , Amit Kumar Ram , Pazhanivel Mohan , Biju Pottakkat

Background and aims

Decreased nitric oxide (NO) bioavailability in a cirrhotic liver contributes to high intrahepatic vascular resistance (IHVR) and portal hypertension (PHT). Nostrin is an inhibitory protein of NO synthesising enzyme endothelial NO synthase (eNOS), shown to increase in cirrhosis with PHT, however, the precise molecular mechanism is poorly documented. This study aimed to elucidate the role of Nostrin and associated derangement in hepatic NO generation in cirrhotic liver. Further, we investigate whether Nostrin could be a biomarker in the progression of cirrhosis.

Methods

This study was conducted on sixty healthy subjects and 120 cirrhotic patients. In addition, liver tissue samples were collected from cirrhotic patients for the analysis of Nostrin, eNOS and inflammatory markers.

Results

When compared to healthy controls, systemic levels of Nostrin and cGMP were elevated in compensated cirrhosis. In decompensated cirrhosis, further robust increases in Nostrin and cGMP were noted. Furthermore, Nostrin expression was considerably higher whilst reduced eNOS activity and hepatic cGMP levels in cirrhotic liver compared to control liver.

Conclusions

In cirrhotic patients, a robust increase in hepatic Nostrin expression may reduce eNOS activity and associated local NO generation. Furthermore, Blood Nostrin concentration was higher and parallel to disease severity and could be a key diagnostic and prognostic biomarker in cirrhotic patients with PHT.

背景和目的肝硬化患者体内一氧化氮（NO）生物利用率降低，导致肝内血管阻力（IHVR）增高和门静脉高压（PHT）。Nostrin是一氧化氮合成酶内皮一氧化氮合酶（eNOS）的抑制蛋白，在肝硬化伴门静脉高压时Nostrin会增加，但其确切的分子机制却鲜有记载。本研究旨在阐明 Nostrin 在肝硬化肝脏 NO 生成中的作用及相关失调。方法本研究以 60 名健康受试者和 120 名肝硬化患者为对象。结果与健康对照组相比，代偿期肝硬化患者全身 Nostrin 和 cGMP 水平升高。失代偿期肝硬化患者的 Nostrin 和 cGMP 水平进一步升高。此外，与对照组肝脏相比，肝硬化肝脏中的 Nostrin 表达明显升高，同时 eNOS 活性和肝脏 cGMP 水平降低。此外，血Nostrin浓度较高，且与疾病严重程度平行，可作为PHT肝硬化患者诊断和预后的关键生物标志物。

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引用次数: 0

Incidence and risk factors for thromboembolic events in pediatric-onset inflammatory bowel disease: A French population-based study 儿科炎症性肠病血栓栓塞事件的发生率和风险因素：一项基于法国人口的研究。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.09.005

Nicolas Richard , Ariane Leroyer , Delphine Ley , Claire Dupont , Valérie Bertrand , Pauline Wils , Corine Gower-Rousseau , Dominique Turck , Nathalie Guillon , Hélène Sarter , Guillaume Savoye , Mathurin Fumery

Introduction

Patients with inflammatory bowel disease (IBD) are at higher risk of thromboembolic events (TE). In pediatric-onset IBD, more data on incidence and risk factors of venous (VTE) and arterial events (ATE) at the population level are needed to guide thromboprophylaxis.

Methods

All patients aged ≤ 16 years diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 1988 and 2011 in the prospective EPIMAD population-based registry were followed until 2013. Every TE occurring during the follow-up period was included.

Results

A total of 1,344 patients were included: 1,007 with CD and 337 with UC, and a median diagnosis age of 14.3 years. After a median follow-up of 8.3 years, 2 (0.15 %) ATE and 15 (1.1 %) VTE occurred at median age of 20.4 years. The global incidence rate of thromboembolic events was 1.32 per 1000 person-years. Periods of active disease (HR=8.4, p = 0.0002), the 3-month-period following surgery (HR=16.4, p = 0.0002) and hospitalization (HR=21.7, p < 0.0001) were found to be associated with an increased risk of VTE. A lower rate of VTE was found in patients treated with 5-aminosalicylates (HR=0.1, p = 0.002).

Conclusion

The risk of TE was low in this population. VTE were strongly associated with active disease, surgery and hospitalization.

导言：炎症性肠病（IBD）患者发生血栓栓塞事件（TE）的风险较高。在小儿IBD患者中，需要更多关于静脉（VTE）和动脉事件（ATE）发生率和风险因素的数据，以指导血栓预防：方法：对1988年至2011年间在前瞻性EPIMAD人群登记中确诊为克罗恩病（CD）或溃疡性结肠炎（UC）的所有年龄≤16岁的患者进行随访，直至2013年。随访期间发生的所有TE均被纳入：结果：共纳入 1,344 名患者：结果：共纳入 1,344 名患者：1,007 名 CD 患者和 337 名 UC 患者，中位诊断年龄为 14.3 岁。中位随访 8.3 年后，2 例（0.15%）ATE 和 15 例（1.1%）VTE 发生，中位年龄为 20.4 岁。血栓栓塞事件的总体发病率为每千人年 1.32 例。活动期（HR=8.4，p = 0.0002）、术后 3 个月（HR=16.4，p = 0.0002）和住院期（HR=21.7，p < 0.0001）与 VTE 风险增加有关。使用5-氨基水杨酸盐治疗的患者VTE发生率较低（HR=0.1，P=0.002）：结论：在这一人群中，TE 的风险较低。VTE与活动性疾病、手术和住院密切相关。

{"title":"Incidence and risk factors for thromboembolic events in pediatric-onset inflammatory bowel disease: A French population-based study","authors":"Nicolas Richard , Ariane Leroyer , Delphine Ley , Claire Dupont , Valérie Bertrand , Pauline Wils , Corine Gower-Rousseau , Dominique Turck , Nathalie Guillon , Hélène Sarter , Guillaume Savoye , Mathurin Fumery","doi":"10.1016/j.dld.2024.09.005","DOIUrl":"10.1016/j.dld.2024.09.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with inflammatory bowel disease (IBD) are at higher risk of thromboembolic events (TE). In pediatric-onset IBD, more data on incidence and risk factors of venous (VTE) and arterial events (ATE) at the population level are needed to guide thromboprophylaxis.</div></div><div><h3>Methods</h3><div>All patients aged ≤ 16 years diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 1988 and 2011 in the prospective EPIMAD population-based registry were followed until 2013. Every TE occurring during the follow-up period was included.</div></div><div><h3>Results</h3><div>A total of 1,344 patients were included: 1,007 with CD and 337 with UC, and a median diagnosis age of 14.3 years. After a median follow-up of 8.3 years, 2 (0.15 %) ATE and 15 (1.1 %) VTE occurred at median age of 20.4 years. The global incidence rate of thromboembolic events was 1.32 per 1000 person-years. Periods of active disease (HR=8.4, <em>p</em> = 0.0002), the 3-month-period following surgery (HR=16.4, <em>p</em> = 0.0002) and hospitalization (HR=21.7, <em>p</em> < 0.0001) were found to be associated with an increased risk of VTE. A lower rate of VTE was found in patients treated with 5-aminosalicylates (HR=0.1, <em>p</em> = 0.002).</div></div><div><h3>Conclusion</h3><div>The risk of TE was low in this population. VTE were strongly associated with active disease, surgery and hospitalization.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 584-594"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development and validation of the PHM-CPA model to predict in-hospital mortality for cirrhotic patients with acute kidney injury 开发并验证用于预测急性肾损伤肝硬化患者院内死亡率的 PHM-CPA 模型。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.09.012

Luyan Zheng, Jing Yang, Lingzhu Zhao, Chen Li, Kailu Fang, Shuwen Li, Jie Wu , Min Zheng

Background

The presence of acute kidney injury (AKI) significantly increases in-hospital mortality risk for cirrhotic patients. Early prognosis prediction for these patients is crucial. We aimed to develop and validate a machine learning model for in-hospital mortality prediction for cirrhotic patients with AKI.

Methods

Data from cirrhotic patients with AKI hospitalized at the First Affiliated Hospital of Zhejiang University between January 1, 2013, and December 31, 2020 were used to train and validate an extreme Gradient Boosting model to predict in-hospital mortality risk. The Boruta algorithm was used for variable selection. The optimal model was selected and named as PHM-CPA (Prediction of in-Hospital Mortality for Cirrhotic Patients with AKI). The PHM-CPA model was then externally validated in patients from eICU Collaborative Research Database (eICU-CRD) and Medical Information Mart for Intensive Care III dataset (MIMIC). The predictive performance of PHM-CPA model was compared with that of logistic regression (LR) model and 25 previously reported models.

Results

A total of 519 cirrhotic patients with AKI were enrolled in model training cohort, of whom 118 (23%) died during hospitalization. Fifteen variables from common laboratory tests were selected to develop the PHM-CPA model. The PHM-CPA model achieved an AUROC of 0.816 (95% CI, 0.763–0.861) in the internal validation cohort and 0.787 (95% CI, 0.745–0.830) in the external validation cohort. The PHM-CPA model consistently outperformed the LR model and 25 previously reported models.

Conclusion

We developed and validated the PHM-CPA model, comprising readily available clinical variables, which demonstrated superior performance and calibration in predicting in-hospital mortality for cirrhotic patients with AKI.

背景：急性肾损伤（AKI）的出现大大增加了肝硬化患者的院内死亡风险。对这些患者进行早期预后预测至关重要。我们旨在开发并验证一种机器学习模型，用于预测 AKI 肝硬化患者的院内死亡率：我们使用浙江大学附属第一医院 2013 年 1 月 1 日至 2020 年 12 月 31 日期间住院的 AKI 肝硬化患者的数据，训练并验证了预测院内死亡风险的极端梯度提升模型。变量选择采用 Boruta 算法。选出的最优模型被命名为 PHM-CPA（肝硬化 AKI 患者院内死亡率预测）。随后，PHM-CPA 模型在来自 eICU 合作研究数据库（eICU-CRD）和重症监护医学信息市场 III 数据集（MIMIC）的患者中进行了外部验证。PHM-CPA模型的预测性能与逻辑回归（LR）模型和之前报道的25个模型进行了比较：共有 519 名肝硬化 AKI 患者加入模型训练队列，其中 118 人（23%）在住院期间死亡。PHM-CPA模型选取了常见实验室检测中的15个变量。PHM-CPA 模型在内部验证队列中的 AUROC 为 0.816（95% CI，0.763-0.861），在外部验证队列中的 AUROC 为 0.787（95% CI，0.745-0.830）。PHM-CPA模型的表现一直优于LR模型和之前报道的25种模型：我们开发并验证了 PHM-CPA 模型，该模型由现成的临床变量组成，在预测 AKI 肝硬化患者的院内死亡率方面表现出卓越的性能和校准性。

{"title":"Development and validation of the PHM-CPA model to predict in-hospital mortality for cirrhotic patients with acute kidney injury","authors":"Luyan Zheng, Jing Yang, Lingzhu Zhao, Chen Li, Kailu Fang, Shuwen Li, Jie Wu , Min Zheng","doi":"10.1016/j.dld.2024.09.012","DOIUrl":"10.1016/j.dld.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>The presence of acute kidney injury (AKI) significantly increases in-hospital mortality risk for cirrhotic patients. Early prognosis prediction for these patients is crucial. We aimed to develop and validate a machine learning model for in-hospital mortality prediction for cirrhotic patients with AKI.</div></div><div><h3>Methods</h3><div>Data from cirrhotic patients with AKI hospitalized at the First Affiliated Hospital of Zhejiang University between January 1, 2013, and December 31, 2020 were used to train and validate an extreme Gradient Boosting model to predict in-hospital mortality risk. The Boruta algorithm was used for variable selection. The optimal model was selected and named as PHM-CPA (<strong>P</strong>rediction of in-<strong>H</strong>ospital <strong>M</strong>ortality for <strong>C</strong>irrhotic <strong>P</strong>atients with <strong>A</strong>KI). The PHM-CPA model was then externally validated in patients from eICU Collaborative Research Database (eICU-CRD) and Medical Information Mart for Intensive Care III dataset (MIMIC). The predictive performance of PHM-CPA model was compared with that of logistic regression (LR) model and 25 previously reported models.</div></div><div><h3>Results</h3><div>A total of 519 cirrhotic patients with AKI were enrolled in model training cohort, of whom 118 (23%) died during hospitalization. Fifteen variables from common laboratory tests were selected to develop the PHM-CPA model. The PHM-CPA model achieved an AUROC of 0.816 (95% CI, 0.763–0.861) in the internal validation cohort and 0.787 (95% CI, 0.745–0.830) in the external validation cohort. The PHM-CPA model consistently outperformed the LR model and 25 previously reported models.</div></div><div><h3>Conclusion</h3><div>We developed and validated the PHM-CPA model, comprising readily available clinical variables, which demonstrated superior performance and calibration in predicting in-hospital mortality for cirrhotic patients with AKI.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 485-493"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pancreatic steatosis is a strong risk factor for post-ERCP pancreatitis: An emerging concept 胰腺脂肪变性是ERCP术后胰腺炎的一个重要风险因素：一个新概念。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.10.005

Caroline Prouvot , Myriam Boumaiza , Khawla Maoui , Anne Sophie Peaucelle , Soiwafi Mohamed , Hanae Boutallaka , Claire Boutet , Xavier Roblin , Jean-Marc Phelip , Rémi Grange , Nicolas Williet

Objective

The Endoscopic Retrograde Cholangiopancreatography (ERCP) is the treatment of choice for biliary obstruction but is associated with post-ERCP pancreatitis (PEP) in around 5 % of cases. No radiological criteria have been evaluated for predicting PEP risk.

Design

This retrospective study examined records of 1365 patients who underwent ERCP at our center between 2014–2023. Only sphincterotomy-naïve patients were included. CT scans within 30 days of ERCP were reviewed for radiological criteria. The optimal pancreatic density cut-off was determined using AUROC and Youden index. Logistic regression was used for analyses.

Results

PEP occurred in 75 patients (6.1 %). The CT scan was performed before ERCP for 565 of the total population. A fatty pancreas, defined as a spontaneous density less than -50HU, was statistically associated with PEP (OR: 7.35; 95 % CI: 1.56–26.5 p = 0.004), as well as with biliary obstruction due to stones (OR: 0.61; 95 % CI: 0.38–0.98; P = 0.04), the need for precut (OR: 2.19; 95 % CI: 1.35–3.51; P = 0.001), cannulation of the main pancreatic duct (OR: 2.23; 95 % CI: 1.36–3.59; P = 0.001), and the use of a pancreatic stent (OR: 2.48; 95 % CI: 1.29–4.47; P = 0.004). In multivariate analyses, only obstruction unrelated to gallstones (OR = 2.63; 95 % CI: 1.16–6.25; P = 0.024) and a low pancreatic density (<-50HU) (OR=7.94, 95 %CI: 1.59–31.09; P = 0.005) remains significantly associated with the risk of PEP, including after adjustment for age and sex (P = 0.006).

Conclusion

A very low pancreatic fat density could be a significant risk factor for post-ERCP pancreatitis with potential clinical and research implications. Further validation is needed.

目的：内镜逆行胰胆管造影术（ERCP）是治疗胆道梗阻的首选方法，但约有5%的病例与ERCP术后胰腺炎（PEP）有关。目前尚未对预测 PEP 风险的放射学标准进行评估：这项回顾性研究检查了 2014-2023 年间在本中心接受 ERCP 的 1365 名患者的记录。仅纳入了括约肌切开术无效的患者。对ERCP术后30天内的CT扫描进行了放射学标准审查。使用AUROC和Youden指数确定最佳胰腺密度临界值。分析采用逻辑回归法：结果：75 名患者（6.1%）出现 PEP。所有患者中有 565 人在 ERCP 之前进行了 CT 扫描。脂肪胰腺（定义为自发密度小于 -50HU）与 PEP（OR：7.35；95 % CI：1.56-26.5；P = 0.004）以及结石导致的胆道梗阻（OR：0.61；95 % CI：0.38-0.98；P = 0.04）有统计学关联。04）、需要预先切开（OR：2.19；95 % CI：1.35-3.51；P = 0.001）、主胰管插管（OR：2.23；95 % CI：1.36-3.59；P = 0.001）和使用胰腺支架（OR：2.48；95 % CI：1.29-4.47；P = 0.004）。在多变量分析中，只有与胆结石无关的梗阻（OR = 2.63；95 % CI：1.16-6.25；P = 0.024）和胰腺脂肪密度低（结论：胰腺脂肪密度非常低会导致胆结石）才会导致胆结石：胰腺脂肪密度极低可能是ERCP术后胰腺炎的重要风险因素，具有潜在的临床和研究意义。需要进一步验证。

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引用次数: 0

Translating knowledge into policy: Organizational model and minimum requirements for the implementation of a regional pancreas unit network 将知识转化为政策：实施地区胰腺单位网络的组织模式和最低要求。

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease

Pub Date : 2025-02-01 DOI: 10.1016/j.dld.2024.05.022

Gianpaolo Balzano , Michele Reni , Maria Di Bartolomeo , Marta Scorsetti , Augusto Caraceni , Piero Rivizzigno , Alessandro Amorosi , Alessandro Scardoni , Mohammad Abu Hilal , Giovanni Ferrari , Roberto Labianca , Massimo Venturini , Claudio Doglioni , Luca Riva , Riccardo Caccialanza , Silvia Carrara

Pancreatic and periampullary cancers pose significant challenges in oncological care due to their complexity and diagnostic difficulties. Global experiences underscore the crucial role of multidisciplinary collaboration and centralized care in improving patient outcomes in this context. Recognizing these challenges, Lombardy, Italy's most populous region, embarked on establishing pancreas units across its territory to enhance clinical outcomes and organizational efficiency. This initiative, driven by a multistakeholder approach involving the Lombardy Welfare Directorate, clinicians, and a patient association, emphasizes the centralization of complex care in high-volume hospitals, adopting a hub-and-spoke model and a multidisciplinary approach. This article outlines the process and criteria set forth for pancreas unit implementation, aiming to provide a structured framework for enhancing pancreatic cancer care. Central to this initiative is the establishment of structured criteria and minimal requirements, not only for surgery but also for other essential components of care, ensuring a comprehensive approach to pancreatic cancer management. The Lombardy model offers a structured framework for enhancing pancreatic cancer care, with potential applicability to other regions and countries seeking to improve their cancer care infrastructure

胰腺癌和胰腺周围癌因其复杂性和诊断困难，给肿瘤治疗带来了巨大挑战。全球经验表明，多学科协作和集中治疗在改善患者预后方面发挥着至关重要的作用。认识到这些挑战后，意大利人口最多的伦巴第大区开始在全境建立胰腺科，以提高临床疗效和组织效率。这一举措由伦巴第大区福利局、临床医生和患者协会等多方共同推动，强调将复杂的医疗服务集中到大容量医院，采用中心辐射模式和多学科方法。本文概述了胰腺单元的实施过程和标准，旨在为加强胰腺癌护理提供一个结构化框架。这一举措的核心是建立结构化的标准和最低要求，不仅针对手术，还针对其他重要的护理环节，确保以全面的方法管理胰腺癌。伦巴第模式为加强胰腺癌治疗提供了一个结构化框架，有可能适用于寻求改善癌症治疗基础设施的其他地区和国家。

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引用次数: 0